Who Pays for Future Medical Treatment After a Car Accident in Arizona?

One of the hardest questions after a serious car accident is not how to pay the medical bills you have today. It is figuring out who will pay for treatment you may need six months, two years, or even ten years from now.

The short answer is this: If another person caused your Arizona car accident, compensation for reasonably necessary future medical treatment may be included in your personal injury claim. In most cases, however, the at-fault driver’s insurance company will not simply keep your claim open and pay medical bills as they arrive for years to come.

Future medical expenses generally need to be identified, supported with medical evidence, valued, and included in your settlement or court award before the case ends.

That distinction can make an enormous difference in a serious injury claim.

Future Medical Treatment Can Be Part of an Arizona Injury Claim

Arizona’s recommended civil jury instructions specifically recognize reasonable expenses for necessary medical care, treatment, and services that are reasonably probable to be incurred in the future as a potential element of personal injury damages. You can review the State Bar of Arizona’s personal injury damages jury instructions for additional information.

Future treatment might include:

• Surgery or additional medical procedures
• Physical or occupational therapy
• Pain management and injections
• Follow-up visits with specialists
• Diagnostic imaging
• Prescription medication
• Medical equipment or assistive devices
• Rehabilitation or long-term care

Whether a particular expense can be recovered depends on the medical evidence and circumstances of the individual case.

The important point is that an injury claim should not necessarily be valued by looking only at the medical bills that have already arrived.

At Perez Law Group, we believe one of the most important questions in a serious accident claim is: What will this injury cost the client after the case is over?

Who Actually Pays for Future Medical Care?

There are two different questions hidden inside “Who pays?”

The first is who pays the doctor or hospital when you receive treatment.

The second is who should ultimately bear the financial responsibility because another person’s negligence caused the injury.

Those answers are not always the same.

The At-Fault Driver’s Liability Insurance

The at-fault driver’s bodily injury liability insurance is usually one of the primary sources of compensation after an Arizona car accident.

A settlement can include compensation for both medical expenses already incurred and qualifying future medical expenses. Arizona law currently requires most automobile liability policies issued or renewed in the state to provide at least $25,000 in bodily injury coverage for one injured person and $50,000 when two or more people are injured, subject to the individual limit. You can review Arizona’s automobile liability insurance requirements in A.R.S. § 28-4009.

Unfortunately, $25,000 can disappear quickly when someone suffers a significant neck, back, brain, orthopedic, or other serious injury.

Perez Law Group discusses this problem in more detail in What Happens When Your Medical Bills Exceed the At-Fault Driver’s Policy Limits?

Your Own Underinsured Motorist Coverage

If the at-fault driver’s insurance is not enough to cover the full value of your injuries, another important source may be your own underinsured motorist coverage, commonly called UIM coverage.

Under Arizona law, underinsured motorist coverage can apply when the available liability insurance is less than the total damages caused by the accident, to the extent the damages exceed the applicable liability limits. More information is available in A.R.S. § 20-259.01.

That can become especially important when future surgery or long-term treatment substantially increases the value of a claim.

This is one reason Perez Law Group does not look only at the other driver’s insurance card. A serious accident can require examining all potentially available insurance coverage.

Health Insurance and Other Medical Coverage

Your health insurance may pay for treatment while your accident claim is pending. Depending on your policy, Medical Payments coverage, commonly called MedPay, may also help with certain accident-related medical expenses.

But using health insurance does not necessarily answer the larger question of who is financially responsible for the injury.

Arizona law also allows qualifying health care providers to assert liens against certain liability recoveries for treatment provided to an injured person. More information about health care provider liens is available in A.R.S. § 33-931. Other reimbursement rights may also arise depending on the type of health coverage involved.

That means the final settlement calculation can be considerably more complicated than simply adding together the bills.

How Do You Prove Future Medical Expenses?

An insurance adjuster is unlikely to accept a statement such as, “My back may hurt forever, so I might need surgery someday.”

Arizona courts require more.

In Saide v. Stanton, the Arizona Supreme Court explained that the need for future medical care must be reasonably probable, with evidence giving the fact finder a basis to determine the probable nature and cost of that treatment. The court also emphasized that a jury cannot simply be left to speculate about what treatment might occur or what it might cost. The decision can be reviewed through Justia’s Arizona Supreme Court case archive.

Interestingly, the court also explained that a medical expert does not necessarily have to use a specific “magic word” such as “probable.” The evidence is considered as a whole.

In practical terms, a well-supported future medical claim may involve evidence such as a physician’s prognosis, recommended procedures, frequency of future appointments, expected duration of treatment, medical records, treatment costs, and expert analysis when the injuries are especially severe.

For catastrophic injuries, a life care planner or other qualified expert may sometimes be necessary to estimate the cost of care over many years.

Illustrative Case Study: The $18,000 Claim That Is Not Really an $18,000 Claim

Consider a hypothetical Arizona driver who is rear-ended and suffers a significant cervical disc injury.

Several months later, she has accumulated $18,000 in medical expenses. She has undergone physical therapy and injections, but continues to experience pain, weakness, and difficulty working.

If someone evaluates her claim using only that $18,000 figure, they may miss the most important part of the case.

Suppose her treating specialist believes additional procedures will probably be necessary and that surgery may ultimately be required. The future treatment must be investigated before settlement. The analysis should include the probable treatment, expected costs, recovery period, effect on employment, and any long-term limitations.

Now suppose the other driver carries only Arizona’s $25,000 minimum bodily injury limit, while the injured woman has applicable UIM coverage of her own.

Suddenly, identifying future medical needs is not simply about increasing a settlement demand. It could affect which insurance policies should be pursued and how the entire claim is handled.

The example is hypothetical, but the issue is common: today’s medical bills do not always tell you what today’s accident will eventually cost.

Why Settling Too Early Can Be Expensive

Insurance companies do not have to wait until every injured person reaches the end of treatment before making an offer.

An early offer can look attractive when bills are arriving, income has been interrupted, and the injured person wants the accident behind them.

But accepting a settlement normally requires releasing the responsible parties and insurer from further liability. That can prevent an injured person from requesting additional compensation later if symptoms worsen or additional treatment becomes necessary.

Imagine accepting a settlement in September and learning the following February that you need surgery related to the collision. If you already signed a full release, you generally cannot simply ask the insurance company to reopen the claim because your medical situation changed.

That is why understanding your prognosis can be so important before settlement.

The same concern applies when treatment is interrupted. An insurer may question whether later medical care was actually related to the collision. Read Can a Gap in Medical Treatment Hurt an Arizona Car Accident Claim? for a closer look at that issue.

What Should You Do If Your Doctor Says You May Need Future Treatment?

Do not ignore the recommendation simply because the treatment is months or years away.

Ask your doctor what they expect your recovery to look like, what additional care may become necessary, and whether those recommendations are documented in your medical records.

Continue following reasonable medical recommendations and keep your attorney informed about new referrals, imaging, procedures, or changes in your condition.

Most importantly, do not evaluate a settlement only by asking whether it will pay the bills sitting on your kitchen table today.

You should also be asking whether it reasonably accounts for the medical bills that may be coming tomorrow.

If symptoms appeared gradually after your collision, you may also find How Long After a Car Accident Can Injuries Appear? helpful.

What If There Is Not Enough Insurance?

This is where a careful investigation becomes particularly important.

In addition to the at-fault driver’s liability coverage and potentially applicable UM or UIM insurance, the facts of an accident can sometimes reveal other potentially responsible parties or sources of coverage.

Insurance limits matter because even a strong future medical claim does not automatically create unlimited insurance coverage.

The legal team therefore needs to evaluate both sides of the equation: What are the client’s total damages, and what sources may be available to pay them?

Our Glendale car accident attorneys handle claims involving medical expenses, lost income, pain and suffering, and other accident-related losses.

Talk to Perez Law Group Before Accepting a Settlement

Future medical treatment is one of the easiest parts of a car accident claim to underestimate because the bill does not exist yet.

But the injury may already exist.

If your doctor expects ongoing treatment, additional procedures, surgery, rehabilitation, or long-term medical management, those future needs deserve careful consideration before your case is resolved.

Perez Law Group, PLLC represents people injured in car accidents throughout Glendale, Phoenix, the West Valley, and communities across Arizona.

Call (602) 730-7100 to schedule a consultation with Perez Law Group. You can also learn more about our Arizona personal injury practice.

The material in this article is for general informational purposes and is not legal advice. Every accident and insurance claim is different.